Article

The Pararectus approach for anterior intrapelvic management of acetabular fractures: an anatomical study and clinical evaluation.

University of Bern, Department of Orthopaedic and Trauma Surgery, Inselspital, Bern 3010, Switzerland.
Journal of Bone and Joint Surgery - British Volume (impact factor: 2.83). 03/2012; 94(3):405-11. DOI:10.1302/0301-620X.94B3.27801
Source: PubMed

ABSTRACT A new anterior intrapelvic approach for the surgical management of displaced acetabular fractures involving predominantly the anterior column and the quadrilateral plate is described. In order to establish five 'windows' for instrumentation, the extraperitoneal space is entered along the lateral border of the rectus abdominis muscle. This is the so-called 'Pararectus' approach. The feasibility of safe dissection and optimal instrumentation of the pelvis was assessed in five cadavers (ten hemipelves) before implementation in a series of 20 patients with a mean age of 59 years (17 to 90), of whom 17 were male. The clinical evaluation was undertaken between December 2009 and December 2010. The quality of reduction was assessed with post-operative CT scans and the occurrence of intra-operative complications was noted. In cadavers, sufficient extraperitoneal access and safe instrumentation of the pelvis were accomplished. In the patients, there was a statistically significant improvement in the reduction of the fracture (pre- versus post-operative: mean step-off 3.3 mm (sd 2.6) vs 0.1 mm (sd 0.3), p < 0.001; and mean gap 11.5 mm (sd 6.5) vs 0.8 mm (sd 1.3), p < 0.001). Lesions to the peritoneum were noted in two patients and minor vascular damage was noted in a further two patients. Multi-directional screw placement and various plate configurations were feasible in cadavers without significant retraction of soft tissues. In the treatment of acetabular fractures predominantly involving the anterior column and the quadrilateral plate, the Pararectus approach allowed anatomical restoration with minimal morbidity related to the surgical access.

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    European Journal of Trauma and Emergency Surgery 10/2012; 38(5):489-498. · 0.33 Impact Factor
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Keywords

20 patients
 
acetabular fractures
 
anterior column
 
lateral border
 
mean age
 
minor vascular damage
 
Multi-directional screw placement
 
new anterior intrapelvic approach
 
optimal instrumentation
 
post-operative CT scans
 
rectus abdominis muscle
 
safe dissection
 
so-called 'Pararectus' approach
 
soft tissues
 
statistically significant improvement
 
sufficient extraperitoneal access
 
surgical access
 
surgical management
 
two patients
 
various plate configurations